Q--LACKAWANNA/SPRINGVILLE COMMUNITY BASED OUTPATIENT CLINIC (CBOC) SERVICES IN ERIE COUNTY, NY

5. PROJECT NUMBER (if applicable) CODE 7. ADMINISTERED BY 2. AMENDMENT/MODIFICATION NUMBER CODE 6. ISSUED BY 8. NAME AND ADDRESS OF CONTRACTOR 4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE 9A. AMENDMENT OF SOLICITATION NUMBER 9B. DATED PAGE OF PAGES 10A. MODIFICATION OF CONTRACT/ORDER NUMBER 10B. DATED BPA NO. 1. CONTRACT ID CODE FACILITY CODE CODE Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers E. IMPORTANT: is extended, (a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended. 12. ACCOUNTING AND APPROPRIATION DATA (REV. 11/2016) is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A. 15C. DATE SIGNED B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified. C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF: D. OTHER Contractor 16C. DATE SIGNED 14. DESCRIPTION OF AMENDMENT/MODIFICATION 16B. UNITED STATES OF AMERICA Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect. 15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER 15B. CONTRACTOR/OFFEROR STANDARD FORM 30 PREVIOUS EDITION NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.) (Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.) (If required) (SEE ITEM 11) (SEE ITEM 13) (X) CHECK ONE 13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14. 11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT (Signature of person authorized to sign) (Signature of Contracting Officer) 1 8 0001 12-14-2019 NONE Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave. Canandaigua NY 14424 Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave. Canandaigua NY 14424 To all Offerors/Bidders 36C24219R0014 11-29-2019 X X X 1 This amendment to the above referenced solicitation hereby addresses a portion of vendor questions received through December 13, 2019 and also provides notification of four (4) revisions to the Performance Work Statement (PWS), as described within Attachment 1 to this amendment which begins on page 2. VA anticipates issuance of a separate amendment addressing the remainder of received questions during the week of December 16, 2019. Solicitation response date may be modified as a result. All other terms and conditions remain unchanged and in full force and effect. Allan M. Preston Contracting Officer Page 11 of 11 Attachment 1 Amendment 0001, RFP 36C24219R0014 Effective Date: December 14, 2019 This amendment to the above referenced solicitation hereby addresses a portion of vendor questions received through December 13, 2019 and also provides notification of four (4) revisions to the Performance Work Statement (PWS), as described below: The following paragraph is added to the PWS as paragraph 4.2.2 FINANCIAL ASSESSMENTS, therefore renumbering PWS paragraph 4.2.2 ENROLLMENT VERIFICATION AND EPISODIC CARE FOR UNASSIGNED/UNENROLLED PATIENTS to 4.2.3: 4.2.2 FINANCIAL ASSESSMENTS: Financial assessment is the process known as a Means Test (MT) used by VA to assess a Veteran s attributable income and assets. The MT determines a Veteran s copayment responsibilities, assists in determining enrollment priority group assignment, and assists in evaluating requirements for determining beneficiary travel benefits. Not all Veterans are required to make copayments. For new Veterans to the VA system, a means test/assessment of gross household income must be completed by the Veteran prior to being seen by the contractor s provider. Veterans with a means test conducted 2014 and later will no longer need an annual means test if they have a qualifying Means Test on file. The contractor shall provide a blank 10-10EZR (Renewal Application for Health Benefits) to the Veteran. The Veteran will fill the form out completely (including financial information on page 2). The demographic and financial assessment information will be input into VISTA and maintained by the contractor. For some Veterans, a financial assessment is not required (VA pensioners, service-connected Veterans receiving VA compensation, etc.). Veterans who are in co-pay status (Medicaid recipients and service connected veterans 10-40%) still do a yearly Copay test to determine eligibility for Beneficiary Travel benefits and medication copay exemption. VA will provide the contractor with guidelines regarding Financial Assessments. Questions can be addressed to the Veterans Service Center at 716-862-8829. PWS paragraph 4.6.12 is revised and shall now read as follows: 4.6.12 SUMMARY INFORMATION FOR MENTAL HEALTH (MH) SERVICES: With the exception of the services provided as part of standard primary care noted in subsections 4.6.12.1 through 4.6.12.10 below, VA shall provide all mental health services, including an on-site licensed clinical social worker at both the main CBOC and satellite clinic. The Contractor shall refer patients to a VA Mental Health practitioner for any mental health care needed that cannot be addressed in primary care. Contractor shall use open scheduling to make an appointment for the Veteran. PWS paragraph 4.6.14.9.1 is revised and shall now read as follows: 4.6.14.9.1 Services for tobacco-related disorders need to be provided to those who need them in a manner that is consistent with the 2008 U.S. Public Health Service Clinical Practice Guidelines which can be found at: https://www.ahrq.gov/prevention/guidelines/tobacco/index.html During new patient encounters and at least annually, patients in primary care, appropriate medical specialty care settings, and mental health care services need to be screened for tobacco use. In addition to education and counseling about smoking cessation, evidence-based pharmacotherapy needs to be available for all adult patients using tobacco products. When provided, pharmacotherapy needs to be directly linked to education and counseling. PWS paragraph 4.8.12 is revised and shall now read as follows: 4.8.12 The Contractor shall be responsible for meeting national quality standards and shall comply with mandated policies established by VA. Q1: What is the number of current billable enrollees at each CBOC? VA Response: As of December 10, 2019, there were 1,860 enrollees at Lackawanna (main CBOC) and 841 enrollees at Springville (satellite). Q2: What is the most recent 3 months of invoiced enrollment at each location? VA Response: The most recent 3 months of invoiced enrollment is as follows: Month Lackawanna (Main CBOC) Springville (Satellite) August 2019 1847 856 September 2019 1854 857 October 2019 1871 859 Q3: Please explain what data/formula the VA is using to project the sharply declining enrollment at Lackawanna of 314 over 9 years on? VA Response: The methodology used is a straight line projection conducted using a combination of observed historical enrollments at each site of care extrapolated against US Census Veteran prevalence data for each clinic region. Additionally, future care demands developed for VHA were consulted and mirrored the projections from VAWNYHS. Q4: Please explain why the Government believes enrollment will drop by over 7% in each of the first 2 years of the contract? VA Response: See the response Q3, above. Q5: How many Choice or Mission Act referrals occurred in the past 12 months for enrolled veterans at the CBOC? VA Response: There were 330 Care In The Community consults across both facilities for Fiscal Year (FY) 2019. Q6: Please specify how many of the referrals were for primary care patients? Please specify the types of specialty services by number of patients. VA Response: There were no consults for Primary Care services. Specialty Care consults are as follows: SERVICE NAME QTY ACUPUNTURE 5 ALLERGY 2 BARIATRIC 2 BU CONTRACT NURSING HOME PLACEMENT 8 BVAC DETOX 1 CARDIO EP/ABLAT 1 CARDIO EVNT MON 1 CARDIOLOGY 2 CHIROPRACTIC 17 CONTRACTED ADHC OUTPT 3 CT SCAN 3 DENTAL CARE GENERAL 1 DERMATOLOGY 2 EMERGENCY ROOM 3 ENT 1 GEC ADULT DAY CARE 3 GEC NONSKILLED HOME HEALTH AIDE 69 GEC SKILLED HOME HEALTH 62 GI COLONOSCOPY 2 GI GEN 3 GI IMAGING CT COLONOGRAPHY 1 GYN 2 MRI 8 NEURO BOTOX 2 NEURO SURG 16 NEUROLOGY 4 NEUROSURG SPINE 28 OCCUPATIONAL THERAPY WNY 1 OPHTHAL DIS 1 ORTHO HAND SURG 2 ORTHO SURG 12 ORTHOPEDICS 10 PAIN MGT 4 PHYS THERAPY 30 PODIATRY 1 PULMONARY 4 RADIAT THERAPY 2 ROUT EYE REFRACT 2 SLEEP MED 1 SURGERY 2 ULTRASOUND 1 UROLOGY 5 Grand Total 330 Q7: Will the VA consider closing or merging the Lackawanna CBOC or the Springville CBOC with other nearby clinics if enrollment drops to or below a certain point during the 9 Option Years? VA Response: VAWNYHS does not foresee making modifications to locations of any of the WNY CBOCs at this point in time. Q8: Is the Contractor responsible for providing services to traveling Vets? If so, how many are anticipated per year? VA Response: See PWS paragraph 4.2.2.2 (which is renumbered as 4.2.3.2 as a result of this amendment). The Contractor is responsible for providing services to Traveling Veterans in accordance with VHA Handbook 1101.11(2). Contractor shall provide at no additional cost approximately 20/month nurse-only visits and 10/month provider visits to veterans who are not assigned for care or are pending assignment at the Contractor s outpatient site of care. At no additional cost the contractor shall provide approximately 10/month telehealth visits with the VAMC parent for veterans who are not assigned for care at the Contractor s outpatient site of care. Q9: In order to have a Medical Director on site, is it the Government s intention to staff the Springville location with a full-time MD, even though enrollment is projected to be less than 1,200? Or, would it be acceptable for the Springville location to be staffed with a PACT team led by an NP, and the Medical Director from Lackawanna serve as the Medical Director for both sites but not be on-location? VA Response: Yes, it is acceptable for the Springville location to be staffed with a PACT team led by an NP and the Medical Director from Lackawanna serve as the Medical Director but not be on-location since Springville is the satellite of Lackawanna. Q10: 4.6.9 Clinical Pharmacy Services Page 42: Can the support to the VA CPS be a member of the PACT team or does the Government want to have dedicated CPS support staff? VA Response: An additional FTE is not required. Other team members can be cross utilized to provide support. Q11: How many VA staffed personnel will be providing services at each CBOC. Please list by job title and number of days per month/FTE. VA Response: VA anticipates providing: Licensed Clinical Social Worker at Main CBOC, 1.5 FTE (See PWS paragraph 2.4.3); Licensed Clinical Social Worker at Satellite, 0.5 FTE (See PWS paragraph 2.4.3); On occasion, other VA personnel may be onsite at either site if the needs of a specific Veteran require a face to face appointment. Q12: In the event of provider absence at the Springville CBOC, will tele-primary care be an authorized contingency plan? VA Response: With Primary Care Chief prior approval in a case by case basis. Q13: 4.6.7.1 The Contractor is responsible for the injectable Naloxone. Is that for administering in the clinic for overdose? VA Response: Yes, the contractor is responsible for any and all medications that are to be administered to the patients in the clinic. This includes Naloxone that would need to be administered in clinic for overdose. Q14: Will the VA provide the Naloxone for veterans that need it ordered as a precaution? VA Response: Yes, the VA will provide Naloxone for veterans that need it ordered as a precaution.  The order will need to be entered into CPRS as an outpatient prescription (not an in-clinic medication) and VA will ship directly to the patient s home. Please note, the Contractor is responsible for in-clinic Naloxone as previously addressed. Q15: Will the government confirm who is responsible for supplying ALL of the following vaccines? Are there any additional vaccines required to be supplied by the Contractor? VA Response: See PWS paragraph 4.6.7. The Contractor will be responsible for supplying all medications (and supplies), including any necessary vaccines that are to be administered to the patients in the clinic. Attachment D.9 provides historical utilization data for medications and immunizations administered in clinic for FY 18, however, patient care needs may dictate a requirement for other medications and immunizations, which will be the Contractor s responsibility. Q16: Please confirm that the courier service costs will be borne by the Contractor. Who provides VHA privacy awareness training?  If Contractor provides, will courier service be required once daily or twice daily? VA Response: See PWS paragraph 4.6.3. VA shall provide courier services to pick up the laboratory specimens from both facilities and transport to the Buffalo VA Core Laboratory. VAWNYHS will provide privacy awareness training and ensure that privacy documents are signed and completed for the courier services. The couriers are VA employees. Q17: Who is responsible for setting up a contract with a local ambulance company? Who pays for the transport cost, VA or Contractor? VA Response: Beneficiary Travel has a contract in place for ambulance rides within the WNY Area of Jurisdiction (AOJ).  The Beneficiary Travel Department pays for all medically necessary ambulance rides when documentation within CPRS shows that the ride was clinically indicated. This includes rides from CBOC s to the VAMC, or for rides to a local Non-VA ER for higher level of care. Q18: Please specifically list all mandated POC testing other than stat urine pregnancy test that the Contractor will be required to perform and the estimated quantity of each type of POC test. VA Response: There are no other mandated POC tests at this time. Historical quantities for each site are as follows: Lackawanna (Main CBOC) Pregnancy approximately 60 tests per year INR approximately 775 tests per year Springville (Satellite Clinic) Pregnancy approximately 50 tests per year INR approximately 500 tests per year Q19: 4.6.27.1 Mission Act, Pages 58 and 59: If a patient meets the criteria for Mission Act for care in the community, who s responsibility is it to schedule, follow up, and monitor the care received in the Community? VA Response: If the patient meets eligibility requirements, then the specialty or primary provider will place a Care In The Community consult to the Care In The Community Department.  The Care In The Community Department will receive, review, validate eligibility, process and schedule the community consult.  If follow-up is necessary, then the ordering provider will be alerted for any further needs.  Q20: 4.7 We are currently estimating 10,000 sq ft for the Lackawanna facility with its large enrollment. Would it be acceptable to the VA if the Springville CBOC with nearly half the enrollees is less at 5,000sq ft to 8,000 sq ft? VA Response: Yes as long as all listed space requirements in PWS are met. Q21: 4.7.1.1 Door Openings: Does the VA strongly encourage sliding doors on both sides of the exam s rooms or on the patient side only? VA Response: Patient-side. Q22: 4.7.15.11.3 Return Air System: Is a mailroom required? Is a loading dock required? If not, is the air exchange applicable only to the lobby area? VA Response: Mail Room not required.  Loading Dock not required.  Return air requirements applicable to lobby area only.  Q23: 4.6.20.3 Tele-Dermatology Services:  What are the room requirements? VA Response: See paragraph 4.7.1.6 Telehealth Room . There is no requirement for a separate room for Tele-Dermatology. Q24: 4.6.20.2 Tele-Retinal Services:  What are room requirements? VA Response: See paragraph 4.7.1.6 Telehealth Room . There is no requirement for a separate room for Tele-Retinal. Q25: Are Tele-Dermatology and Tele-Retinal included in the Section 4.7 Space requirements. VA Response: See paragraph 4.7.1.6 Telehealth Room . Separate rooms are not required for Tele-Dermatology and Tele-Retinal. Q26: Does the current facility meet the demands of this RFP? VA Response: The current facilities do not meet the current PACT design guidelines. The VA requires the on-stage/off-stage design elements listed in the PACT Design Manual.  The contractor is responsible for providing adequate space to meet the requirements in the solicitation and resulting contract.  The space requirements in the current solicitation are different than the previous requirement. Q27: 4.7.1.10.1: VA Multi-Use Office: Will the VA s LCSW use this office? Or is a separate office required for the LCSW? VA Response: No, the VA LCSWs will not use the VA Multi-Use Office this space will be used by other VA discipline staff as needed. See PWS paragraph 4.7.1.4 Mental Health for the Mental Health space requirements. Q28: 4.7.1.7: Group Care Room, Page 66: Please advise how many group rooms are required in the CBOC? VA Response: The Contractor must provide at least one (1) Group Care Room meeting the requirements of PWS paragraph 4.7.1.7. Q29: 4.7.15.1.1: Window glazing and façade protection level, with a performance condition as prescribed by WINGARD 4.1 or later or WINLAC 4.3 software. Is this required for all the windows in the lease space to comply or just the front entry windows? VA Response: All exterior windows. Q30: 4.7.1.15: Patient Restroom: Situated between blood draw rooms with pass through windows on each side. Restroom includes a baby changing station. Pass through windows must have locks for patient privacy and security. Should the pass thru window be a locked metal specimen pass thru or an actual window? VA Response: A locked metal specimen pass thru would meet the requirement. Q31: 4.7.1.16 Lab/Blood Draw Room: Shall be a separate dedicated room located near the patient exam rooms. Room shall be a minimum of 120 square feet with pass through window from adjacent patient restroom. Pass through windows must have locks for patient privacy and security. Should the pass thru window be a locked metal specimen pass thru or an actual window? VA Response: A locked metal specimen pass thru would meet the requirement. Q32: 4.7.1.7 Group Care Room/Meeting/Conference Space:  Another carpeted room no less than 360 square feet, sufficient to accommodate up to 15 individuals, inclusive of any group facilitators, and one (1) Telehealth real-time video unit shall be made available. Mental Health meeting/conference space can be used for this purpose. The furnishings required for the larger room include a conference table and power outlets, phone lines, computer connections for equipment, in addition to the furnishing requirements for the mental health offices. Will one room suffice for this requirement at 360 sq ft? Or will another group room be required for Mental Health patients? VA Response: One room meeting the requirements outlined in PWS paragraph 4.7.1.7 is acceptable the VA does not require a separate group room for Mental Health patients. Q33: 4.7.20 Equipment Office supplies and Technical support, Pages 72 and 73:  This section states that all equipment connected to VA network must be owned and controlled by the VA. Section 4.7.20.1.5 states Contractor is responsible for, all printers, copiers, scanners, fa machines, and other peripheral equipment to operate in the facility. Please confirm all printers, lab label printers, fax machines, scanners, and color printers for patient education printouts that VA will supply? VA Response: VA will provide: Lab Printer for labels (printed from VISTA) Desktop Printers so they can print from VISTA, CPRS, Outlook and other Microsoft Programs. Desktop Scanners so they can scan documents into CPRS. VA will not provide: Fax Machine Multi-Function Device (Faxing, printing, scanning, copying) Q34: Does the Government require any special lease stipulations other than what are typically stated in the standard LOI? VA Response: The VA does not require any special lease stipulations. The Contractor is responsible for determining what stipulations are necessary in their lease. Q35: Is the Springville NY CBOC currently open? If so, is it separate or combined with Lackawanna CBOC? What is the name of the Springville CBOC in VSSC? VA Response: Yes, the Springville clinic is currently open and is a satellite clinic of the Lackawanna CBOC. It is separately located in Springville, NY. The Springville satellite clinic is listed under the Lackawanna CBOC in the VSSC as (1V02) (528GQ) Lackawanna, NY. The PACT Teams under Springville have the prefix LA-SP, and Lackawanna have the prefix LA to differentiate between the two PACT sites. Q36: Please confirm the new contractor will inherit the patient s last vesting visit and be allowed to bill for one year from that date upon contract award? VA Response: The Contractor will be provided a list of all enrolled patients at the beginning of the contract. Contractor will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must be seen within twelve (12) months of their last visit. Refer to PWS paragraph 4.6.27.3, which states: 4.6.27.3. The Contractor shall be responsible for ensuring all Veterans assigned to Contractor s site of care in PCMM have at least one qualifying encounter with Contractor s PCP at least every 12 months . Q37: Please provide the most recent monthly billing figures/members/enrollees for the primary and satellite clinics. VA Response: See responses to Q1 and Q2, above. Q38: Are the current facilities designed to meet the VA s standards to accommodate the PACT Model; are the current facilities using the on-stage/off-stage plan? VA Response: See response to Q26, above. Q39: Are the current facilities adequate to meet the size requirements for the current solicitation? VA Response: See response to Q26, above.